Factors associated with adverse mental health outcomes during the COVID-19 pandemic.

Objectives: Even with significant advances to advance the health status of the general American population, the increased prevalence of mental health conditions and re-emergence of highly infectious diseases across all levels of society present a significant threat. This study aimed to quantify the effects of pandemic-, healthcare-related, and sociodemographic variables on adverse mental health outcomes, and determine their relative magnitudes. Study design: This study employed publicly available data from the Household Pulse Survey, conducted by the United States Census Bureau to examine the social and economic impacts of the COVID-19 pandemic on American households. Methods: A multiple regression model formed the basis of analysis, with adverse mental health as the outcome and various pandemic-, healthcare-related, and sociodemographic variables as predictors. Missing data was handled using multiple imputation. Results: The factors with significant contributions to adverse mental health outcomes were those associated with mental health services and prescriptions. General healthcare-related variables followed those specific to mental health, along with sociodemographic variables contributing smaller changes. There were differential outcomes in mental health that were in part attributable to sociodemographic factors, but also a lack of access to both mental and physical healthcare due to factors both related and unrelated to the ongoing pandemic. Conclusions: There is a need for policymakers and other stakeholders to work towards a mental health system that is more robust to restrictions brought on by events like the COVID-19 pandemic, and to address inequities in health care that have been exacerbated.